Wednesday, August 30, 2017

Overcoming Anxiety & Depression on the Autism Spectrum: A Self-Help Guide Using CBT

OVERCOMING ANXIETY AND DEPRESSION ON THE AUTISM SPECTRUM: A SELF-HELP GUIDE USING CBT
Many adults on the autism spectrum experience isolation, interpersonal difficulties, anxiety, depressed mood, and coping problems. Award-winning author Dr. Lee A. Wilkinson's book presents strategies derived from cognitive-behavioral therapy (CBT), adapted specifically for autistic adults with mild symptoms who struggle with social communication skills, to help them manage anxiety and depression, and improve their overall psychological well-being. This self-help guide is written for individuals in the early and middle years of adulthood, with and without a formal diagnosis, who share features associated with autism spectrum conditions. It is also appropriate for adults who recognize their autistic traits, even though they may not have experienced major social difficulties and clinical impairment, but who want to improve their emotional well-being.
 

The author takes the best of CBT therapeutic techniques to facilitate greater self-understanding, self-advocacy, and better decision-making in life-span activities such as employment and interpersonal relationships. Accessible and easy-to-read, this self-help guide provides evidence-based tools that can be used to learn new self-fulfilling ways of thinking, feeling, and doing. It includes questionnaires, forms/worksheets, and exercises to help the reader:

  • Evaluate his or her autistic traits and discover their cognitive style.
  • Identify and modify the thoughts and beliefs that underlie and maintain the cycles of anxiety, depression, and anger.
  • Apply therapeutic techniques such as mindfulness, positive self-talk, guided imagery, and problem-solving.
  • Accept the past and achieve unconditional self-acceptance.
  • Deal effectively with perfectionism and low frustration tolerance.
  • Avoid procrastination and learn to maintain the positive changes to their progress.

Honored as an Award-Winning Finalist in the “Health: Psychology/Mental Health” category of the 2016 Best Book Awards, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT is an essential self-help book for autistic adults on the higher end of the spectrum looking for ways to understand and cope with their emotional challenges and improve their psychological well-being.  Family members, friends, and others touched by autism will also find this self-help book a valuable resource.
Table of Contents
Acknowledgements. 1. Introduction. Adults on the Autism Spectrum. 2. Where Are You on the Autism Spectrum? 3. Self-Analysis and Your Cognitive Style. 4. The ABCs of Emotions. 5. Rationality and Scientific Thinking. 6. Imagery, Mindfulness and Self-Talk. 7. Maintaining Your Changes. Appendix A. Autism Quotient (AQ). Appendix B. Empathy Quotient (EQ). Appendix C. Systemizing Quotient (SQ). Appendix D. ABC Worksheet. Appendix E. Thought - Feeling Worksheet. Appendix F. Unhelpful Thinking Habits Record Form. Appendix G. CBT Self-Help Thought Record Form. Appendix H. Daily Mood and Thought Worksheet. Appendix I. Self-Talk Record Form. Appendix J. Coping Thought Worksheet. Appendix K. Problem Solving Worksheet. Appendix L. Maintaining Change Worksheet. Unhelpful Thinking Habits. Major Irrational Beliefs. Reference List. About the Author.


 Reviews
'From his many years as an autism professional and cognitive-behavioural therapist, Dr Wilkinson shows an excellent understanding of perceptions and thought processes of people on the autism spectrum, which he explains so clearly in a way people on the autism spectrum can relate to. This book will not only help people on the autism spectrum to gain a stronger understanding of who they are, but also offers a way to overcome anxiety and depression by working with their thought processes rather than attempting to 'banish' or 'cure' them. An important resource for a group of people whose needs are not static.' - Chris Mitchell, author of Mindful Living with Asperger’s Syndrome and Asperger’s Syndrome and Mindfulness
'Overcoming Anxiety and Depression on the Autism Spectrum will be of great value to people with autism spectrum conditions who experience anxiety and depression. It is a self-help guide which provides practical advice on living well, tailored to individuals on the autism spectrum. Using strategies based around Cognitive Behaviour Therapy, it offers a positive approach to managing anxiety and depression.' - Jeanette Purkis, autism and mental health self-advocate, author of Finding a Different Kind of Normal: Misadventures with Asperger Syndrome, and The Wonderful World of Work: A Workbook for Asperteens
'When people ask me if there is anything I'd change about my Asperger syndrome, I offer this firm reply: I'd like to shackle and disable my anxiety and depression. They work together as twin dragons bent on disabling confident and reliable thinking. Wilkinson's accurate analysis and applicable supports give me hope and more reason to keep working on defeating these nasties.' - Liane Holliday Willey, author of Pretending to be Normal and Safety Skills for Asperger Women

Overcoming Anxiety and Depression on the Autism Spectrum is available from Jessica Kingsley Publishers, AmazonBarnes & Noble, Book DepositoryBooks-A-Million and other online book retailers.


Get the lowest price on Overcoming Anxiety and Depression on the Autism Spectrum: A Self-help Guide Using CBT from AllBookstores.com.

Lee A. Wilkinson, PhD, NCSP is a licensed and nationally certified school psychologist, chartered psychologist, and certified cognitive-behavioral therapist. He is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers. He is also editor of a best-selling text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

Tuesday, August 15, 2017

Sensory Processing and Food Selectivity in Autism


Sensory Processing and Food Selectivity

Atypical or unusual sensory responses are common in autistic children and often one of the earliest indicators of autism in childhood. A large percentage of children with autism (78 to 90%) have sensory processing problems. Sensory issues are included in the DSM-5 symptom criteria for restricted, repetitive patterns of behavior, interests, or activities (RRBs). These are mostly problems of sensory modulation expressed as hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment. 

When present, sensory problems may interfere with performance in many developmental and functional domains across home and school contexts, including daily living activities such as eating. Research suggests that extreme reactions or rituals involving taste, smell, texture, or appearance of food or excessive food restrictions are fairly common and may be a presenting feature of ASD. Many researchers as well as individuals with autism have suggested that there is a link between the sensory processing problems that a person experiences and difficulties managing daily life. Eating is one of the areas of daily life activities that may be negatively affected by sensory aversions. It has been suggested that sensory sensitivity may lead children with ASDs to restrict their intake to food of preferred, tolerable, and manageable textures. For example, the texture of foods has been consistently identified as a related aspect of food acceptance, suggesting that sensory sensitivity may be a contributing factor to food selectivity.
 Research
A study published in the open access journal, Autism Research and Treatment, examined the relationship between sensory processing and eating problems in children with ASD. A total of 95 Children with a diagnosis of autism, pervasive developmental disorder not otherwise specified (PDD-NOS), or Asperger syndrome, aged 3–10 years, were included in the study. They had at least one other associated condition; the most common being attention deficit disorder (23%), hyperactivity (22%), and intellectual disability (23%). Parents completed two questionnaires: (a) the Eating Profile, which was developed by clinicians and focuses on developmental eating milestones, mealtime behaviors of the child, such as eating autonomy and impact on the daily life of the family and (b) the Short Sensory Profile (SSP), a standardized questionnaire consisting of 38 items that help clinicians and researchers to quickly identify children with sensory processing issues (e.g.., typical response, probable difference, or definite difference).
                                                                                     Results
The results indicated that 65 percent of children in the study showed a definite difference and 21 percent a probable difference in sensory processing on the total score of the Short Sensory Profile. Overall, children with “definite” sensory problems had significantly more eating problems than those with “typical” performance. Children with tactile sensitivity, taste/smell sensitivities, as well as visual/auditory sensitivities had significantly more eating problems than children with typical performance. For the total score of the SSP and for three sections (taste/smell sensitivity; auditory filtering; visual/auditory sensitivity), having a definite problem was significantly associated with a greater number of eating problems as measured by the Eating Profile. Although not statistically significant, there was a tendency for tactile sensitivity to be associated with the number of eating problems. These results could not be explained by age, sex, intellectual disability, attention deficit disorder, or hyperactivity.
                                                                               Discussion
The results of the study suggest that certain sensory modalities may influence the number of eating problems more than others. For example, children who were classified in the “definite difference” category on “tactile sensitivity” showed problems with the social behaviors at mealtime, as well as having unusual food preferences with respect to commercial brands, specific recipes, color, texture, or temperature of the food. These findings support an association of tactile defensiveness and food selectivity in children with autism. Exploration through touching is a preliminary step to the introduction of new foods in young children. Children showing sensory defensiveness might be less inclined to explore foods with their hands. Others may have difficulties with the feel of utensils, the close presence of other children, or the routine clean-up after a meal.
Children with taste and/or smell sensitivity issues had mealtime problems. Similar to tactile sensitivity, they demonstrated problematic mealtime behaviors, but even more pronounced food preferences. This affected the eating autonomy more than tactile sensitivity, primarily in eating without assistance and using eating utensils, such as a fork. Auditory filtering affected these behaviors to the same extent as taste/smell sensitivities. This confirms the notion that eating is a complex multisensory experience.
A significant association was also found between visual/auditory sensitivity and the number of eating problems. Mealtimes can indeed be noisy during the preparation of food, including the manipulation of utensils and ongoing conversations. Even the sound of their own chewing or that of others (Miosphoniacan upset some highly sensitive children. Whether at school, or in child care, the noise level is usually above the one experienced in a child’s home. Likewise, children with visual sensitivities may react more to the visual stimuli of foods which may evoke unpleasant memories of their taste or texture. In typically developing children the visual exploration of food may actually facilitate the expectation of their taste/texture and thereby ease the acceptance of new foods.
                                                                                 Implications
Because sensory hyper- and hyporesponsiveness may be observable in infancy, these findings have implications for early detection and intervention and suggest that autistic children may benefit from timely interventions focusing on the sensory components of eating. Although it remains to be determined how these issues might be specifically addressed in therapy, the frequency and severity of eating problems perceived by parents highlight the need for systematic evaluation of this daily living activity in combination with the sensory processing issues associated with food preferences and their effect on adaptive functioning (e.g., daily living skills). Consequently, an examination of mealtime behaviors might be included as part of the diagnostic assessment, including a sensory profile, in order to provide guidance to caregivers and parents.
Although therapeutic interventions to enhance sensory processing functions are popular in the treatment of autism, the efficacy of these treatments is mixed and continues to be debated among researchers. Nevertheless, best practice guidelines indicate that when indicated, treatment programs for children with autism should integrate an appropriately structured physical and sensory milieu in order to accommodate any unique sensory processing challenges. Of course, all interventions and treatments should be based on sound theoretical constructs, robust methodologies, and empirical studies of effectiveness. Different approaches to intervention have been found to be effective for children with autism, and no comparative research has been conducted that demonstrates one approach is superior to another. The selection of specific interventions should be based on goals developed from a comprehensive assessment of each child’s unique needs and family preferences. A more detailed discussion of assessment domains (e.g. communication, social, RRBs, sensory, academic) can be found in A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).
Resource: Geneviève Nadon, Debbie Ehrmann Feldman, Winnie Dunn, and Erika Gisel, “Association of Sensory Processing and Eating Problems in Children with Autism Spectrum Disorders,” Autism Research and Treatment, vol. 2011, Article ID 541926, 8 pages, 2011. doi:10.1155/2011/541926
Lee A. Wilkinson, PhD, NCSP is a licensed and nationally certified school psychologist, chartered psychologist, and certified cognitive-behavioral therapist. He provides consultation services and best practice guidance to school systems, agencies, advocacy groups, and professionals on a wide variety of topics related to children and youth with autism. He is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHe is also editor of a best-selling text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

Thursday, August 3, 2017

Special Education Eligibilty for Autism: What School Professionals Should Know

Special Education Eligibility for Autism

More children than ever before are being diagnosed with autism spectrum disorders (ASD). The U.S. Centers for Disease Control and Prevention (CDC) now estimates that 1 in 54 eight year-old children has an ASD. This increase in the prevalence of children with ASD over the past decade, together with the clear benefits of early intervention, have created a need for schools to identify children who may have an autism spectrum condition. Understanding the differences between a medical diagnosis and an educational determination of eligibility for special education services can help both parents and professionals become better advocates.
The Individuals withDisabilities Education Improvement Act of 2004 (IDEA) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are the two major systems used to diagnose and classify children with ASD. The DSM-5 is considered the primary authority in the fields of psychiatric and psychological (clinical) diagnoses, while IDEA is the authority with regard to eligibility decisions for special education. The DSM was developed by clinicians as a diagnostic and classification system for both childhood and adult psychiatric disorders. The IDEA is not a diagnostic system per se, but rather federal legislation designed to ensure the appropriate education of children with special educational needs in our public schools. Unlike the DSM-5, IDEA specifies categories of ‘‘disabilities’’ to determine eligibility for special educational services. The definitions of these categories (there are 13), including autism, are the most widely used classification system in our schools. According to IDEA regulations, the definition of autism is as follows:
(c)(1)(i) Autism means a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age 3, that adversely affects a child’s educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences. The term does not apply if a child’s educational performance is adversely affected primarily because the child has an emotional disturbance, as defined in this section.
(ii) A child who manifests the characteristics of ‘‘autism’’ after age 3 could be diagnosed as having ‘‘autism’’ if the criteria in paragraph (c)(1)(i) of this section are satisfied.
This educational definition is considered sufficiently broad and operationally acceptable to accommodate both the clinical and educational descriptions of autism and related disorders. While the DSM-5 diagnostic criteria are professionally helpful, they are neither legally required nor sufficient for determining educational placement. A medical diagnosis from a doctor or mental health professional alone is not enough to qualify a child for special education services. It is state and federal education codes and regulations (not DSM-5) that drive classification and eligibility decisions. In fact, the National Research Council (2001) recommends that all children identified with ASD, regardless of severity, be made eligible for special educational services under the IDEA category of autism. Thus, school professionals must ensure that children meet the criteria for autism as outlined by IDEA or state education agency (SEA) and may use the DSM-5 to the extent that the diagnostic criteria include the same core behaviors. All professionals, whether clinical or school, should have the appropriate training and background related to the diagnosis and treatment of neurodevelopmental disorders. The identification of autism should be made by a professional team using multiple sources of information, including, but not limited to an interdisciplinary assessment of social behavior, language and communication, adaptive behavior, motor skills, sensory issues, and cognitive functioning to help with intervention planning and determining eligibility for special educational services.
Guidelines

Legal and special education experts recommend the following guidelines to help school districts meet the requirements for providing legally and educationally appropriate programs and services to students who meet special education eligibility for autism.
1. School districts should ensure that the IEP process follows the procedural requirements of IDEA. This includes actively involving parents in the IEP process and adhering to the time frame requirements for assessment and developing and implementing the student’s IEP. Moreover, parents must be notified of their due process rights. It’s important to recognize that parent-professional communication and collaboration are key components for making educational and program decisions.
2. School districts should make certain that comprehensive, individualized evaluations are completed by school professionals who have knowledge, experience, and expertise in ASD. If qualified personnel are not available, school districts should provide the appropriate training or retain the services of a consultant.
3. School districts should develop IEPs based on the child’s unique pattern of strengths and weaknesses. Goals for a child with ASD commonly include the areas of communication, social behavior, adaptive skills, challenging behavior, and academic and functional skills. The IEP must address appropriate instructional and curricular modifications, together with related services such as counseling, occupational therapy, speech/language therapy, physical therapy and transportation needs. Evidence-based instructional strategies should also be adopted to ensure that the IEP is implemented appropriately.
4. School districts should assure that progress monitoring of students with ASD is completed at specified intervals by an interdisciplinary team of professionals who have a knowledge base and experience in autism. This includes collecting evidence-based data to document progress towards achieving IEP goals and to assess program effectiveness.
5. School districts should make every effort to place students in integrated settings to maximize interaction with non-disabled peers. Inclusion with typically developing students is important for a child with ASD as peers provide the best models for language and social skills. However, inclusive education alone is insufficient, evidence-based intervention and training is also necessary to address specific skill deficits. Although the least restrictive environment (LRE) provision of IDEA requires that efforts be made to educate students with special needs in less restrictive settings, IDEA also recognizes that some students may require a more comprehensive program to provide FAPE.
6. School districts should provide on-going training and education in ASD for both parents and professionals. Professionals who are trained in specific methodology and techniques will be most effective in providing the appropriate services and in modifying curriculum based upon the unique needs of the individual child.
Adapted from Wilkinson, L. A. (2016). A best practice guide to assessment and intervention for autism spectrum disorder in schools. London and Philadelphia: Jessica Kingsley Publishers.



Key References and Further Reading
Individuals withDisabilities Education Improvement Act of 2004. Pub. L. No. 108-446, 108th Congress, 2nd Session. (2004).
National Research Council (2001). Educating children with autism. Committee on Educational Interventions for Children with Autism. C. Lord & J. P. McGee (Eds). Division of Behavioral and Social Sciences and Education. Washington, DC: National Academy Press.
Twachtman-Cullen, D., & Twachtman-Bassett, J. (2011). The IEP from A to Z: How to create meaningful and measurable goals and objectives. San Francisco, CA: Jossey-Bass.
Wilkinson, L. A. (2010). Best practice in special needs education. In L. A. Wilkinson, A best practice guide to assessment and intervention for autism and Asperger syndrome in schools (pp. 127-146). London: Jessica Kingsley Publishers.
Yell, M. L., Katsiyannis, A, Drasgow, E, & Herbst, M. (2003). Developing legally correct and educationally appropriate programs for students with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 18, 182-191.
Zirkel, P. A. (2014). Legal issues under IDEA. In L. A. Wilkinson (Ed.). Autism spectrum disorder in children and adolescents: Evidence-based assessment and intervention in schools (pp 243-257). Washington, DC: American Psychological Association.
Lee A. Wilkinson, PhD, NCSP is a licensed and nationally certified school psychologist, chartered psychologist, registered psychologist, and certified cognitive-behavioral therapist. He is also a university educator and trainer, and has published widely on the topic of autism spectrum disorders both in the US and internationally. Dr. Wilkinson is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers. He is also editor of a recent volume in the American Psychological Association (APA) School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools, and author of the book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. His most recent book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools, (2nd Edition).
© Lee A. Wilkinson, PhD



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